lines. Furthermore, definite research work must be done if a clinic hopes to develop and perfect the techniques at hand. The question of each worker or department following up a problem, or directing the united efforts of the clinic toward one large research project, is one to be decided. The amount of time to be devoted to research will depend upon the "set-up" of the clinic, but certainly a definite time should be allotted this important phase of work. Then, a clinic should seek to unify the fields of experience. No one clinic working alone can hope to solve the problems at hand. If it can serve as a unifying center for the work of all the social agencies in its community, judiciously guiding their efforts toward the development of a constructive program for the promotion of mental hygiene for the community as a whole, its service will be greatly increased and its influence felt. DIRECT AND INDIRECT METHODS IN THE (ABSTRACT) Lawson G. Lowrey, M.D., Director, Demonstration Child Guidance Since behavior depends not only upon the reacting individual but also upon the situations to which the individual is reacting, it follows that the study and treatment of unacceptable behavior involves an analysis of the total situation, both personal and environmental. The study has for its major object the finding of modifiable factors in this total situation. Not only these modifiable factors must be found, but methods must be evolved for minimizing the importance of the non-modifiable factors which have helped to produce the difficult behavior. It has been found useful to group the various measures which may be utilized to affect behavior into the direct, or those which are used directly upon the patient, and the indirect, or those which are applied to various elements of the environment, with a more desirable level of behavior resulting through changes thus produced in the situations to which the patient must react. In the first, or direct, group of measures are included all medical, surgical, and psychotherapeutic procedures which may be indicated in the individual case, as well as special types of educational effort. These are not necessarily applied by the clinic staff. In fact, all medical and surgical work is done either by the family physician or by the dispensary or hospital with which the patient has a connection. Tutoring, special drill, and various other educational measures are carried by special tutors, by the schools, and so on. The psychotherapeutic work is carried by the clinic staff. All of this is in accordance with the general principle that the clinic should not attempt to duplicate any work going on in the community, but should supplement and coordinate for its specific case prob lems. The majority of cases studied demand some form of direct treatment, either physical or mental, and frequently both. Careful planning and excellent cooperation with various health agencies in the community are quite necessary if treatment is to be had for every case needing it. The measures included under the heading "indirect" are for the most part those ordinarily called "social." Here there seem to be two distinct types of measure: those leading to placement in specialized (and usually simplified) environments; and those directed at various features of the child's usual environments. The great problems at the present time are in the latter field, and there is less and less tendency to depend upon special types of placement. Of course, there are definite groups for which specialized placement is continually demanded, but the general trend is away from such use except where the need is to meet certain very definite handicaps which can be met in no other way. Properly to deal with environmental factors requiring adjustment requires work from many fields: medical, psychiatric, educational, religious, recreational, and all those processes commonly grouped as "social case work." Thus medical or psychiatric treatment of a parent or other person who contributes to the production of behavior problem; education of parent or teacher in the meaning of behavior, with resulting change in their attitude toward the problem; change in educational placement; building up of group contact and life for the patient or parents; by various manipulations providing constructive rather than destructive outlets, etc.; some or all of these may be needed in connection with a particular problem. It is only in the sense that every case presents needs for environmental modification that the clinic can be considered a case working agency. And it uses directly many techniques employed only indirectly by case workers. Primarily it stresses the individual. It seems clear that the effective carrying out of such a program for the individual case, and even more for what has been termed the "mass attack" upon the general problems of behavior, requires the utmost in community organization and cooperation, such that agencies in all fields give to the clinic and its patients what may be needed, while the clinic contributes all it can to their work as well. Such cooperation is splendidly forthcoming in all phases of the work. One of the most important features of such cooperation is its great educational value to the community as a whole. TEACHERS AS BARRIERS TO MENTAL HYGIENE Ralph P. Truitt, M.D., Director, Division on Prevention of De- My own brief experience as a teacher in the public schools has put me slightly on the defensive in dealing with the subject assigned me for discussion. It strikes me as unfair to attach to teachers the stigma of being barriers to mental hygiene. After all, isn't it the teacher's situation, rather than the teacher, which constitutes a barrier, and have we, as social workers and mental hygienists and, last but not least, as taxpayers, the right to call names? How many of us have any real insight into school problems? How many of us know anything about those modern educational methods we want the schools to adopt? The application of special psychiatric criteria and methods to education is still a novelty and we are quite hazy, not only about the institution we would like to see reformed, but about the reforms themselves. Possibly one difficulty with us has been our failure to grasp the implications of the fact that the public school represents the most powerful agency in the field of child welfare, that it touches practically every child, and has jurisdiction over him during the important formative years. Yet, perhaps of all agencies dealing with the child, the school is farthest removed from the application of social concepts to its job, and continues bound hand and foot to purely pedagogical problems. The advanced courses in university schools of education and the contents of educational journals deal almost exclusively with school administration, and educational thinking has not yet squarely faced the issues of socialization. Perhaps the job of tactfully confronting educators, educational politicians, and teachers with mental hygiene and social issues is one that belongs to us, and the opportunity for an alliance between the schools and social work exists if we see fit to take advantage of it. In the first place, the school situation has to be diagnosed if we are to know what should be done to realize the social possibilities of education. The schools are still quite generally in the hands of politicians who play football with school funds and divert public attention from their activities with oratory centering about the three R's, the poor taxpayers, and the necessity for preserving the federal Constitution. The teacher is ordinarily underpaid and, as a hireling, seldom consulted about school policies. Few school systems have sufficient plant, and many devote most of their thought to the problem of how many children they can squeeze into a certain number of seats. Classes are crowded and teachers are forced to consider the traffic duties of getting children in and out of classrooms and halls as one of their major duties. Moreover, school organization is an organization of hierarchies, based on feudal condition, and concerned not only with the discipline of children, but of teachers as well. The teacher becomes a cog in the machine. She is subjected to a monotonous routine, carries a deadening amount of clerical work, and thinks of her own development largely in terms of examinations for small promotions. Put in charge of large, unsorted classes, she has to be a policeman, preserving law and order, establishing discipline as a necessary preliminary to teaching. She has little chance to know and understand her pupils as feeling and thinking individuals; she knows them only as a mass of pedagogical material, to be forced through the "learning process" in a given time. Her curriculum, laid down by a "system," is rigid and full. It gives her no room for initiative, depersonalizes see that much so-called "bad" behavior is perfectly good biological behavior, that the youngster's resistance to rigid authority may be essentially wholesome, that his failures in attention may be indictments of unsuitable curriculum, and that his restlessness may spring from normal but thwarted desires for physical and mental outlets the schoolroom denies him. That he is a sensitive personality, passing through innumerable phases of development, showing at times the emotional stresses of unadjustment, is something the average teacher cannot grasp. She is prone to make snap judgments and label the child for the term of his school career. A single slip may brand him as a thief, a liar, a pervert, and if he does not react to shaming or moralizing appeals he is dismissed as hopeless, and sent on from grade to grade with a growing legend. Sometimes he is damned by his so-called heredity, and not seen as an individual, with possibilities of his own, because his older brothers were school problems, or his parents ne'er-do-wells. Quite commonly, the school dodges its responsibility by resorting to the practice of expelling its unfit or by consigning them to such special scrap-heaps as truant schools and bad boys' schools, facilities of which it is, on the whole, rather proud. The fundamental aim of the school in education should be the adjustment of the child to himself, and this adjustment includes not only his intellectual training, but equally the releasing of all of his energies for proper adjustment in life. Through the teachers and through the subject-matter they teach, through the social contacts which should be maintained with the home, he should be brought to see himself objectively and realize the relation between himself and his difficulties. Instead of allowing him to flounder in bewilderment in a special class, school, or otherwise, he should be helped to discover the connection between his behavior and other people's reactions to it. Understanding of this on the child's part would be the basis of a real moral and ethical training. The school, in cooperation with those dealing with the child in his home, should clear the way in helping him to realize his good points, develop his abilities, and express himself to the nth degree. The school should make it possible for him to face his weaknesses and disabilities without shame or inferiority and to compensate for these in a proper social way. It is a recognized fact that many mental hygiene problems begin with the child entering kindergarten, and that all the school's further effort to educate him is futile. It is not too early on his first admission to the school system to discover what sort of educational material the child presents and what problems the school must expect to meet in dealing with him. By the time the child enters kindergarten his personality development may have been distorted by maladjusted parents, by inadequate habit training, by physical handicaps, and by his reactions to his own difficulties. The exactions made by the kindergarten may be too much for him, and his real possibilities may be obscured for the rest of his school career because his energies were not redirected when the school first got hold of him. The school's dealing with children is handicapped by super |